<include file="public@header"/>
</head>
<body>
	<div class="wrap ">
		<ul class="nav nav-tabs">
			<li><a href="{:url('customer/index')}">{:lang('ADMIN_CUSTOMER_INDEX')}</a></li>
			<li class="active"><a href="{:url('customer/add')}">{:lang('ADMIN_CUSTOMER_ADD')}</a></li>
		</ul>
		<form class="form-horizontal js-ajax-form" action="{:url('Customer/add_post')}" method="post" >
			<fieldset>
                <div class="control-group">
					<label class="control-label">{:lang('逝者姓名')}</label>
					<div class="controls">
						<input type="text" name="deceased_name" value="" id="deceased_name" class="form-control"/>
					</div>
				</div>
				<div class="control-group">
					<label class="control-label">{:lang('GENDER')}</label>
                    <div class="controls">
                        <select name="deceased_sex" class="form-control">
                            <option value="1">男</option>
                            <option value="2">女</option>
                        </select>
                       <!-- <span class="form-required">*</span>-->
                    </div>
				</div>
				<div class="control-group">
					<label class="control-label">{:lang('STATUS')}</label>
                    <div class="controls">
                        <select name="deceased_status" class="form-control">
                            <option value="1">健在</option>
                            <option value="2">已故</option>
                        </select>
                    </div>
				</div>
                <div class="control-group">
					<label class="control-label">{:lang('来访人姓名')}</label>
					<div class="controls">
						<input type="text" name="customer_name" value="" id="customer_name" class="form-control" required/>
						<span class="form-required">*</span>
					</div>
				</div>
                <div class="control-group">
					<label class="control-label">{:lang('CONTACT_PHONE')}</label>
					<div class="controls">
						<input type="text" name="customer_phone" value="" id="customer_phone" class="form-control" required/>
						<span class="form-required">*</span>
					</div>
				</div>
                <div class="control-group">
					<label class="control-label">{:lang('BUDGET')}</label>
					<div class="controls">
						<input type="text" name="price_budget" value="" id="price_budget" class="form-control"/>
					</div>
				</div>
                <div class="control-group">
					<label class="control-label">{:lang('INTENTION')}</label>
					<div class="controls">
						<textarea name="customer_desc" class="form-control"></textarea>
					</div>
				</div>
				<!--<div class="control-group">
					<label class="control-label">{:lang('ORDER_STATUS')}</label>
                    <div class="controls">
                        <select name="order_state">
                            <option value="unfinished">未完成</option>
                            <option value="goods">无产品</option>
                            <option value="free">空闲</option>
                            <option value="retain">保留</option>
                            <option value="reserve">预定</option>
                            <option value="deposit">定金</option>
                            <option value="buy">已购买</option>
                        </select>
                    </div>
				</div>-->
                <div class="control-group">
					<label class="control-label">{:lang('登记人')}</label>
					<div class="controls">
						<input type="text" value="{$name}"  class="form-control" readonly/>
					</div>
				</div>
			</fieldset>
			<div class="form-actions">
				<button type="submit" class="btn btn-primary js-ajax-submit">{:lang('ADD')}</button>
				<a class="btn btn-default" href="javascript:history.back(-1);">{:lang('BACK')}</a>
			</div>
		</form>
	</div>
	<script type="text/javascript" src="__STATIC__/js/admin.js?v={:time()}"></script>

    
</body>
</html>




